History

Most affected children are healthy and asymptomatic at presentation, with an unremarkable medical history. Occasionally, patients may report a current and/or recent episode of upper respiratory tract infection, adenopathy/lymphadenopathy, fever, otitis media, or diarrhea. In rare instances, other children in the family may also have asymmetric periflexural exanthem of childhood. Mild pruritus is reported in approximately 50% of patients.

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Physical

The primary (pathognomonic) lesion is a small erythematous papule with a surrounding pale halo. The general appearance of lesions includes a morbilliform, eczematous, and occasionally reticulated group of macules, papules, or coalescent plaques. These are occasionally accompanied with fine scaling.

At the initial onset, lesions are unilateral and usually begin near the axillae, lateral trunk, and upper inner arm or groin. During the course of the condition, lesions often progress bilaterally with an asymmetric predominance.

The 4 sequential stages of the lesions are as follows:

Eczematous, when initial lesions occur on the axillae and lateral chest wall

Coalescence, when lesions extend to the trunk and proximal extremities and are separated by areas of normal skin

Regression, when older lesions may develop a central dusky-gray center

Desquamation, when residual branlike scale appears and resolves with time

Asymmetric periflexural exanthem of childhood lesions spare the face, palms, soles, and mucous membranes. Lichenification is not usually observed. See the images below.

Morbilliformlike eruption in a child with involvement of the axilla, lateral thorax, and abdomen. Used with permission from McCuaig et al (1996) from the Journal of the American Academy of Dermatology.

Eczematouslike eruption with a predominantly hemicorporeal distribution photographed on the eighth day after initial appearance of lesions. Used with permission from Bodemer and de Prost (1992) from the Journal of the American Academy of Dermatology.

Morbilliformlike eruption in a child with involvement of the axilla, lateral thorax, and abdomen. Used with permission from McCuaig et al (1996) from the Journal of the American Academy of Dermatology.

Eczematouslike eruption with a predominantly hemicorporeal distribution photographed on the eighth day after initial appearance of lesions. Used with permission from Bodemer and de Prost (1992) from the Journal of the American Academy of Dermatology.

Pattern of reticulated plaques on the posterior lower limb of a child. Used with permission from McCuaig et al (1996) from the Journal of the American Academy of Dermatology.

Histopathologic slide demonstrates perivascular, interstitial, and periadnexal infiltrate of lymphocytes and histiocytes in the deep dermis (hematoxylin-phloxine-saffron stain). Used with permission from McCuaig et al (1996) from the Journal of the American Academy of Dermatology.

Histopathologic slide demonstrates epidermal spongiosis and lymphocytic infiltration of the intraepidermal portion of an eccrine duct (hematoxylin-phloxine-saffron stain). Used with permission from McCuaig et al (1996) from the Journal of the American Academy of Dermatology.

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration